Objective:To investigate the risk factors and their predictive efficacy for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 216 pediatric patients with distal tibial epiphyseal fractures admitted to Zhengzhou Orthopedics Hospital from January 2018 to December 2023, including 136 males and 80 females, aged 2-16 years [11.8(9.8, 13.3)years]. Among them, 112 patients were affected on the left side and 104 on the right. According to the Salter-Harris fracture classification, the fracture was classified as type I in 14 patients, type II in 97, type III in 38, type IV in 64 and type VI in 3. According to the presence of premature epiphyseal closure after surgery, the patients were divided into premature epiphyseal closure group ( n=38) and normal epiphyseal group ( n=178). Age, gender, body mass index (BMI), injury mechanism, side of injury, Salter-Harris classification of fracture, initial displacement distance of the fracture end, medial malleolar involvement by the fracture line surgical fixation method, operation duration, reduction method, and reduction quality were recorded in the two groups. Univariate analysis and binary Logistic regression analysis were used to evaluate and determine the independent risk factors for postoperative premature physeal closure in pediatric patients with distal tibial epiphyseal fracture. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was calculated to evaluate the predictive efficacy of each risk factor for the occurrence of premature physeal closure in pediatric patients with distal tibial epiphyseal fractures. Results:Univariate analysis showed the occurrence of postoperative premature epiphyseal closure of the distal tibia was associated with age, Salter-Harris fracture classification, medial malleolar involvement by the fracture line, surgical fixation method, reduction method, and reduction quality ( P<0.05), while it was not correlated with gender, BMI, injury mechanism, side of injury, initial displacement distance of the fracture end, and operation duration ( P>0.05). Multivariate binary Logistic regression analysis showed that medial malleolar involvement by the fracture line ( OR=0.18, 95% CI 0.04, 0.76, P<0.05) and reduction quality ( OR=43.18,95% CI 10.71, 174.05, P<0.01) were significantly correlated with the occurrence of postoperative premature epiphyseal closure of the distal tibia. The results of ROC curve analysis showed that medial malleolar involvement by the fracture line had limited predictive efficiency (AUC=0.53, 95% CI 0.43, 0.63), reduction quality had moderate predictive efficacy (AUC=0.81, 95% CI 0.72, 0.91), while their combination demonstrated even higher predictive efficacy (AUC=0.83, 95% CI 0.74, 0.91). Conclusions:Medial malleolar involvement by the fracture line and reduction quality are independent risk factors for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures. Reduction quality demonstrates good predictive efficacy, while medial malleolar involvement by the fracture line shows limited predictive value. The combination of both factors achieves even better predictive performance.

Objective To explore the protective effect of polydatin and its mechanism on secondary liver injury in silicosis rats based on network pharmacology and animal experiments. Methods i) Network pharmacology study. Based on multiple databases, the targets of polydatin effect related to silicosis and liver injury were collected, and the common targets of polydatin-silicosis-liver injury were screened to construct a protein-protein interaction network. Enrichment analyses were performed to identify core targets involved in the effects of polydatin on silicosis-associated secondary liver injury. The mechanism of action of polydatin in relieving silicosis and silicosis-associated secondary liver injury was investigated, in which polydatin served as molecular docking ligand. ii) Animal experimental validation. Specific pathogen free male SD rats were randomly divided into three groups, with 10 rats per group. Rats in the model and intervention groups received 1 mL of a silica suspension at a mass concentration of 50 g/L for modeling using a one-time non-tracheal exposure method. Then rats in the intervention group were injected intraperitoneally with polydatin solution at 30 mg/kg body weight, once daily starting from the first day after silica exposure, whereas rats in the control group received no treatment. Lung and liver histopathology of rats, which were randomly sacrificed on days 28 and 56 post-exposure in both groups, were examined. Biomarkers of liver injury and hepatic oxidative stress were measured, and hepatic expression of nuclear factor erythroid 2-related factor 2 (NRF2) related proteins was detected by Western blotting. Results i) Network pharmacology study results. A total of 137 polydatin-related targets, 14 812 silicosis-related targets, and 3 038 liver injury-related targets were identified, among which 69 were common targets and 28 were key targets. Gene Ontology analysis indicated that the key targets were involved in 1 883 pathways. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis identified 137 pathways related to the targets. Molecular docking showed good binding affinities between polydatin and B-cell lymphoma 2 (BCL2), interleukin 6 (IL-6), tumor necrosis factor (TNF), and NRF2. ii) Animal experimental validation results. Compared with the control group, rats in the model group showed increased collagen deposition in both lung and liver tissues, with hepatic degeneration, necrosis, and inflammatory cell infiltration on days 28 and 56 after silica exposure. The collagen in lung and liver tissues of rats on days 28 and 56 after silica exposure increased in the model group compared with the control group (all P<0.05). Meanwhile, serum alanine aminotransferase and aspartate aminotransferase activities, hepatic lactate dehydrogenase 5 activities and NADPH: quinone oxidoreductase 1 (NQO1) expression in liver tissue increased (all P<0.05), whereas hepatic superoxide dismutase activity and NRF2 expression were decreased (all P<0.05). The level of malondialdehyde and the relative expression of heme oxygenase-1 (HO-1) protein in liver tissue in rat of model group were higher than those in the control group (all P<0.05). These alterations were ameliorated in rats of the intervention group compared with the model group (all P<0.05). Conclusion Polydatin exerts protective effects against secondary liver injury in rats with silicosis. These effects may be mediated by regulation of core targets such as BCL2, IL6, TNF, and NRF2, modulation of inflammatory pathways including TNF and IL17 signaling, and activation of the NRF2/HO-1 pathway, thereby exerting synergistic anti-inflammatory, antioxidant, and antifibrotic effects via the "lung-liver axis".

Objective:To investigate the clinical effectiveness of tumor lesion curettage and allogeneic bone grafting via the fovea of femoral head through the surgical hip dislocation approach in children and adolescents with femoral head chondroblastoma (FHCB).Methods:Case series study.The clinical data of 7 FHCB patients [3 males and 4 females with a mean age of 13.7 years (11-19 years)] treated at the Department of Pediatric Orthopedics, Zhengzhou Orthopedic Hospital from January 2016 to March 2023 were retrospectively analyzed.All patients underwent lesion curettage and allogeneic bone grafting via the fovea of femoral head through the surgical hip dislocation approach.The healing, local recurrence and complications were assessed via clinical and radiological tests.Functional outcomes were evaluated using the Musculoskeletal Tumour Society (MSTS) scoring system.A paired t-test was used to compare the MSTS scores before the operation and at the final follow-up. Results:All patients were followed up for 30 months on average (18-48 months).The average healing time for bone grafting was 4.9 (3-8) months.Local recurrence and serious postoperative complications such as avascular necrosis of femoral head, secondary osteoarthritis, ectopic ossification and nonunion of greater trochanter osteotomy end were not observed in all patients up to the last follow-up.The average MSTS score at the last follow-up was (29.14±0.45) points.Conclusions:Curettage and bone grafting via the fovea of femoral head through the surgical hip dislocation approach is effective and safe in the treatment of FHCB in children and adolescents.This method can maintain the integrity of the articular surface and growth plate, and also preserve the blood supply of the femoral head and the normal function of the hip joint, with satisfactory short-term effects.

Objective To investigate the drivers,stakeholders,core tasks,and differentiated development models of digital transformation in Chinese hospitals,develop a hospital digital transformation model,and propose advancement pathways.Methods Leveraging ROCCIPI theory,socio-technical systems theory,and social network theory,a multiple case study approach was employed to analyze four representative Chinese hospitals,examining the driving factors,social network relationship,and core tasks of digital transformation.Results Hospital digital transformation is a complex process driven by regulations,opportunities,and capabilities,requiring efficient collaboration among stakeholders focused on patient services,clinical operations,hospital management,and security.It identified three development models-ecology-oriented,regional integration,and grassroots enhancement—based on the distinct characteristics of the hospitals.A theoretical model for digital transformation in four Chinese hospitals was developed,along with proposed pathways and strategies.Conclusion It presents a digital transformation model and advancement pathways for hospitals through multiple case analyses,addressing the limited perspectives of existing research and providing a reference for practice.

Objective To investigate the drivers,stakeholders,core tasks,and differentiated development models of digital transformation in Chinese hospitals,develop a hospital digital transformation model,and propose advancement pathways.Methods Leveraging ROCCIPI theory,socio-technical systems theory,and social network theory,a multiple case study approach was employed to analyze four representative Chinese hospitals,examining the driving factors,social network relationship,and core tasks of digital transformation.Results Hospital digital transformation is a complex process driven by regulations,opportunities,and capabilities,requiring efficient collaboration among stakeholders focused on patient services,clinical operations,hospital management,and security.It identified three development models-ecology-oriented,regional integration,and grassroots enhancement—based on the distinct characteristics of the hospitals.A theoretical model for digital transformation in four Chinese hospitals was developed,along with proposed pathways and strategies.Conclusion It presents a digital transformation model and advancement pathways for hospitals through multiple case analyses,addressing the limited perspectives of existing research and providing a reference for practice.

Objective:To investigate the clinical effectiveness of tumor lesion curettage and allogeneic bone grafting via the fovea of femoral head through the surgical hip dislocation approach in children and adolescents with femoral head chondroblastoma (FHCB).Methods:Case series study.The clinical data of 7 FHCB patients [3 males and 4 females with a mean age of 13.7 years (11-19 years)] treated at the Department of Pediatric Orthopedics, Zhengzhou Orthopedic Hospital from January 2016 to March 2023 were retrospectively analyzed.All patients underwent lesion curettage and allogeneic bone grafting via the fovea of femoral head through the surgical hip dislocation approach.The healing, local recurrence and complications were assessed via clinical and radiological tests.Functional outcomes were evaluated using the Musculoskeletal Tumour Society (MSTS) scoring system.A paired t-test was used to compare the MSTS scores before the operation and at the final follow-up. Results:All patients were followed up for 30 months on average (18-48 months).The average healing time for bone grafting was 4.9 (3-8) months.Local recurrence and serious postoperative complications such as avascular necrosis of femoral head, secondary osteoarthritis, ectopic ossification and nonunion of greater trochanter osteotomy end were not observed in all patients up to the last follow-up.The average MSTS score at the last follow-up was (29.14±0.45) points.Conclusions:Curettage and bone grafting via the fovea of femoral head through the surgical hip dislocation approach is effective and safe in the treatment of FHCB in children and adolescents.This method can maintain the integrity of the articular surface and growth plate, and also preserve the blood supply of the femoral head and the normal function of the hip joint, with satisfactory short-term effects.

Objective:To investigate the risk factors and their predictive efficacy for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 216 pediatric patients with distal tibial epiphyseal fractures admitted to Zhengzhou Orthopedics Hospital from January 2018 to December 2023, including 136 males and 80 females, aged 2-16 years [11.8(9.8, 13.3)years]. Among them, 112 patients were affected on the left side and 104 on the right. According to the Salter-Harris fracture classification, the fracture was classified as type I in 14 patients, type II in 97, type III in 38, type IV in 64 and type VI in 3. According to the presence of premature epiphyseal closure after surgery, the patients were divided into premature epiphyseal closure group ( n=38) and normal epiphyseal group ( n=178). Age, gender, body mass index (BMI), injury mechanism, side of injury, Salter-Harris classification of fracture, initial displacement distance of the fracture end, medial malleolar involvement by the fracture line surgical fixation method, operation duration, reduction method, and reduction quality were recorded in the two groups. Univariate analysis and binary Logistic regression analysis were used to evaluate and determine the independent risk factors for postoperative premature physeal closure in pediatric patients with distal tibial epiphyseal fracture. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was calculated to evaluate the predictive efficacy of each risk factor for the occurrence of premature physeal closure in pediatric patients with distal tibial epiphyseal fractures. Results:Univariate analysis showed the occurrence of postoperative premature epiphyseal closure of the distal tibia was associated with age, Salter-Harris fracture classification, medial malleolar involvement by the fracture line, surgical fixation method, reduction method, and reduction quality ( P<0.05), while it was not correlated with gender, BMI, injury mechanism, side of injury, initial displacement distance of the fracture end, and operation duration ( P>0.05). Multivariate binary Logistic regression analysis showed that medial malleolar involvement by the fracture line ( OR=0.18, 95% CI 0.04, 0.76, P<0.05) and reduction quality ( OR=43.18,95% CI 10.71, 174.05, P<0.01) were significantly correlated with the occurrence of postoperative premature epiphyseal closure of the distal tibia. The results of ROC curve analysis showed that medial malleolar involvement by the fracture line had limited predictive efficiency (AUC=0.53, 95% CI 0.43, 0.63), reduction quality had moderate predictive efficacy (AUC=0.81, 95% CI 0.72, 0.91), while their combination demonstrated even higher predictive efficacy (AUC=0.83, 95% CI 0.74, 0.91). Conclusions:Medial malleolar involvement by the fracture line and reduction quality are independent risk factors for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures. Reduction quality demonstrates good predictive efficacy, while medial malleolar involvement by the fracture line shows limited predictive value. The combination of both factors achieves even better predictive performance.

Objective:To explore the active ingredients of shengxian and jinshuiliujun decoction with the method of network pharmacology, and to verify the experimental mechanism of its treatment of silicosis.Methods:In May 2023, the active ingredients and targets of drugs in shengxian and jinshuiliujun decoction were obtained through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database. The target of silicosis disease was screened by databases such as Genecards, Disease Gene Network (DisGeNET), Comparative Toxicogenomics Database (CTD), etc. The screened drug targets and disease targets were intersected to obtain the target set of shengxian and jinshuiliujun decoction for the treatment of silicosis. Protein-protein interaction (PPI) network analysis was performed on the target set through STRING database, and core target genes were screened. GO enrichment analysis and KEGG pathway analysis of intersection genes were performed based on Metascape database, and molecular docking verification of key components and targets of shengxian and jinshuiliujun decoction was carried out. Twenty-four adult male SD rats with SPF grade were randomly divided into control group, model group and TCM intervention group, with 8 rats in each group. The dust-stained rat model was prepared by non-tracheal exposure of 1 ml silica suspension (50 mg/ml) in one go, and TCM intervention group was given shengxian and jinshuiliujun decoction[6 g/ (kg·d) ] on the second day. The CT of the lungs of each group was observed 28 days after the dust-stained rat model. Paraffin sections of rat lung tissues were prepared and stained with Hematoxylin-Eosin (HE) and Masson. Western blot was used to verify the expression of core target-related proteins in rat lung tissues after the intervention of shengxian and jinshuiliujun decoction for 28 days, and the differences in protein expression between groups were compared by one-way analysis of variance.Results:A total of 205 active ingredients and 3345 active compounds were selected from shengxian and jinshuiliujun decoction, corresponding to 281 targets, among which 240 targets were related to silicosis. Serine/threonine kinase 1 (AKT1), tumor protein p53 (TP53), tumor necrosis factor (TNF) and interleukin (IL) 6 may be the key targets of shengxian and jinshuiliujun decoction in the treatment of silicosis. Through enrichment analysis, 30 GO entries and 20 potential signaling pathways were screened according to P-value, including nuclear factor κB (NF-κB), mitogen-activated protein kinase (MAPK) and cancer signaling pathways. Molecular docking showed that the active compounds of shengxian and jinshuiliujun decoction had good binding with the core target proteins, and the strongest binding properties were beta-sitosterol and TNF-α (-10.45 kcal/mol). In animal experiments, the inflammatory infiltration and fibrosis of lung tissue of rats in TCM intervention group were significantly improved. Compared with control group, the levels of TNF-α, IL-1β, IL-6 and NF-κB in lung tissue of model group were significantly increased ( P<0.05). Compared with model group, the lung injury of rats in TCM intervention group was significantly improved, and the expressions of TNF-α, IL-1β, IL-6 and NF-κB were significantly decreased ( P<0.05) . Conclusion:Shengxian and jinshuiliujun decoction in the treatment of silicosis may play an anti-fibrosis role by inhibiting the NF-κB signal transduction pathway mediated by inflammatory factors such as TNF-α and IL-1β, which provides a reference for further exploring the material basis and mechanism of its action.

Objective To investigate the accuracy and feasibility of shear wave elastography(SWE)combined with superb microvascular imaging(SMI)for the differential diagnosis of benign and malignant thyroid nodules.Methods A total of 190 patients with thyroid nodu-les detected in the Ultrasound Department of our hospital from January 2021 to December 2022 who underwent ultrasound-guided fine-needle aspiration biopsy or exhibited postoperative histopathological improvement were selected as the study subjects.Among them,a total of 224 thyroid nodules(74 benign and 150 malignant nodules)were detected,all of whom underwent thyroid ultrasonography,SWE,and SMI.The parameters related to the Young's modulus of the tissue as well as the condition of fine blood flow and perforating vessels were calculated.Using histopathological results as the gold standard to construct receiver operating characteristic(ROC)curves,observe the effectiveness of SWE combined with SMI in the differential diagnosis of thyroid nodules,and compare the efficacy of different examination methods in the diagnosis of thyroid nodules.Results There were significant differences in the internal composition,echo,margin,cal-cification,and aspect ratio between the benign and malignant thyroid nodules(all P<0.05);however,there was no significant difference in the average diameter of the benign and malignant nodules(P>0.05).There were statistically significant differences in maximum elas-ticity,mean elasticity,elasticity ratio,microvascular score,peak shear wave velocity,and average shear wave velocity between the benign and malignant thyroid nodules(all P<0.05).The ROC curve showed that the area under the curve of the maximum elastic value was the highest,while the optimal diagnostic threshold was 29.52 kPa.The optimal diagnostic threshold for the microvascular flow score was 2.3 points.In terms of diagnostic efficacy,SWE combined with SMI showed the highest sensitivity(94.67%)and specificity(94.59%).Conclusion SWE combined with SMI can further improve the diagnostic efficiency of benign and malignant thyroid nodules and achieve quantitative evaluation and dynamic observation of lesions,which has application and promotion value.

Objective:To establish a high-performance liquid chromatography (HPLC) characteristic spectrum of Radix Actinidiae Chinensis decoction pieces, standard decoction and formula granules; To simultaneously determine the contents of index components; To study the transfer law of formula granules based on the extraction amount, content of Catechin and characteristic spectrum of standard decoction.Methods:15 batches of Radix Actinidiae Chinensis decoction pieces were collected, the standard decoction was prepared, and the extraction amount was measured. The HPLC fingerprints of decoction pieces, standard decoction and formula granules were established, and the characteristic peaks were calibrated and attributed. The content of Catechins in decoction pieces, standard decoction and formula granules was measured, and the transfer rate law was calculated. The yield rate, the common peak transmission number of fingerprints, the content and the transfer rate were the main evaluation indexes, and the law of the transmission of the magnitude value was analyzed.Results:The paste yield of 15 batches of Radix Actinidiae Chinensis standard decoction ranged from 3.9%-6.3%. A total of 4 characteristic peaks were calibrated in the feature map, and peak 2 was identified as Protocatechuic acid and peak 4 as Catechin; 6 characteristic peaks were detected in Actinidia chinensis Planchon decoction pieces, standard decoction and formula granules, and their relative retention times were all within the specified range. The content of Catechins in Radix Actinidiae Chinensis decoction pieces was 0.4%-1.4%, which was 3.8%-4.9% in formula granules. The transfer rate of decoction pieces-standard decoction was 13.6%-38.3%, and the decoction-formula granules was 15.5%-21.2%.Conclusions:The mass transfer between Radix Actinidiae Chinensis decoction pieces, standard decoction and formula granules has a good migration. The formula granules also have a good correlation and consistency with the standard decoction, which indicating that the preparation process of Radix Actinidiae Chinensis is reasonable and feasible.